Thursday, June 28, 2012

Game Plan

This is the story behind our current story. Statistics are involved. And not many adjectives. But it's how we got here, whether we like it or not.

One of the most unexpectedly difficult things about infertility are the anniversaries. These are the days to which you’d already said your goodbyes. Like that last-gasp Halloween party where you dressed up and acted like a kid again, one last time before you had a kid. Only now it’s Halloween again, and this year you don’t feel like dressing up at all. The Thanksgiving where you smiled at the thought of a baby smaller than next year’s turkey. But a year later, there’s just another turkey. That “last Christmas as just the two of you,” which turns into another Christmas with the same number of stockings hung. (Thank goodness your spoiled cats get stockings, too, or the sight of only two would be too sad to bear.) And then there are the weddings. People announce wedding dates far enough in advance that it’s easy to believe you’ll have a belly by the time the big day rolls around. And then one by one, you toast newlyweds with champagne instead. Time marches on.

Enough was enough. A year and a half after first trying to conceive on our own, we became patients at a fertility clinic. Our reproductive endocrinologist ran new fertility screens on us and came to this unhelpful diagnosis: Unexplained Infertility. Further rounds of poking and prodding and running dye through my fallopian tubes yielded nothing more than confirmation: Unexplained Infertility. I had mixed feelings about this diagnosis. On the one hand, my inner overachiever loved hearing that nothing was wrong with us. On the other hand, something obviously was wrong, or we’d be parents by now. Surely there had to be some answer out there, something specific we could try to correct. But no. We were answering every question correctly, yet still failing the exam.

Our doctor suggested we try Intrauterine Insemination (IUI), which facilitates fertilization by placing sperm directly into the uterus. Although we knew my husband’s guys could already swim and my ladies were ready and willing, the doctor believed a medicated IUI would improve our chances without the additional intervention (and cost) of In-Vitro Fertilization (IVF). We’d try IUI for a few rounds, and if that didn’t work, we’d move on to IVF.

According to our doctor, 85% of all couples trying to conceive have about a 20% chance of getting pregnant each month. For a couple like us, diagnosed with Unexplained Infertility, our au naturel chances are only 2-3% each month. Having an IUI without supplemental medications doesn’t meaningfully increase our chances, nor do medications without an IUI. We agreed with our doctor that an IUI plus medications was the best course for us, but this involved choices of its own.

We could take Clomid, an oral medication, and raise our chances from 2-3% to about 4-6%. Or we could choose an injectable medication and raise our chances to about 6-9% per month. There are pros and cons to both, but I disliked what I’d read and heard about Clomid much more than what I’d read and heard about injectables. Besides the obvious discomfort factor of injecting needles into yourself, the injectable route does come with one big risk: a multiple pregnancy. IUI + Clomid has about a 7% chance of having a multiple pregnancy, but IUI + Injectables has about a 30% chance of a multiple pregnancy. (Head spinning from percentage chances already? Here’s another fun one for you: if IUI doesn’t work for us and we move on to IVF, we’ll have about a 40-45% chance of conceiving each month, and only a 25% chance of a multiple pregnancy, but with 0% insurance coverage.)

If you’re now thinking we’re crazy to go through IUI and injectables for an at-best 9% chance of conceiving each month, which comes with needles and a 30% chance of having a zoo of children, you wouldn’t be alone. We thought that, too, when we first started trying. Now, though… it doesn’t sound so crazy at all.

We’re lucky that our insurance pays for a good percentage of an IUI cycle. The thought of IVF terrifies our bank accounts, so it’s prudent to try every other possibility first. Last December, though, as we faced a year of unknowns and all the pressures that come with that, we did something crazy instead of being prudent: we flew to Paris for Christmas to forget our troubles. We had a game plan for 2012, but we had the City of Lights to explore first. And it was worth it.

14 comments:

If you do go the IVF route, the injections really aren't at all bad. But yeah, it really is painful on the wallet. I wish more insurance covered it. Some insurance will cover the meds, which is a big expensive part of it, but ours didn't cover any of it. :-/

I have had two friends that have done IUI. One ended up with one child and the other with twins. I know a "zoo" isn't ideal, but they absolutely love having twins. The struggle to conceive was so rough on them emotionally, that they were thrilled to have two and be done.

Sending lots of positive thoughts your way- I know it's hard to share things this personal, but I also know that you are likely helping so many people.

We were in what sounds like the same boat. Our dr didn't give us all of those percentages, but said basically the same thing about our chances and advice of what to do, and to add to your litany, he told us that it was "very likely" that we would get pregnant on our own "within the next 4 years" (after about 15 months of try at that point) since they didn't see anything wrong, if we wanted to just keep waiting for it to happen. Which we didn't. I got pregnant on our 2nd IUI with follistim, and now have a 2-month old (singleton) girl. I am wishing you so much luck!

I was diagnosed with unexplained recurrent pregnancy loss and I had the same feelings. I was so relieved to find out there was nothing wrong with me (AJ only had to have a chromosome blood test, since I obviously was getting pregnant...lucky man), but two minutes later I was crying because that meant there wasn't something we could "fix". I know our situations are different, but similar statistics were hurled at us regarding carrying to term and it was so depressing. Our RE went the kitchen sink route and something in the magical med cocktail (or nothing, perhaps) seems to have worked this time. Fingers crossed that IUI and injectibles works magic for you!

The term "unexplained" as part of a medical diagnosis blows my mind. Can't they use some Latin word for that?

We're definitely not at this stage yet, but I always think how scary it is that you try so hard for so long not to get pregnant that you never think what it might be like to one day not be able to once you're trying. I hope this works out for you, and if it doesn't for whatever reason, I'm adopted and I give it rave reviews :).

I started to read this post on Friday, but I was already a low day & couldn't get through it. I finally was able to read it. I'm in a very similar situation as you. We are at the 1.5 year mark of trying & in September are having the IUI conversation with our doctor. I've been going back and forth in my mind with the clomid vs. injectibles, too. I'm leaning away from clomid, but just not sure. Thank you so much for being so brave to share this journey. It makes me feel not so "alone" in this whole thing. xoxo.

Its amazing how many people have had such a similar struggle. I was always able to find comfort in knowing that its "not just me". For my husband and myself, we chose the IUI with clomid route after a year and half of trying and then discovering that both of us had minor malfunctions prohibiting pregnancy. I am happy to say that after our first IUI attempt we are 18 weeks pregnant with twins. While I admit twins wasn't our initial plan, I couldn't be happier with our blessings and the road before us. Good luck to you!